Ongoing conversations about suicide prevention
Reprinted from "Suicide" issue of Visions Journal, 2005, 2 (7), p. 4-5
We met in 1995. With 10 years of discussions, respectful challenges and collaborative endeavours under our belts, our dialogue continues and questions still arise. This editorial highlights some of what keeps us wondering and ‘wandering’ across diverse intellectual, personal, political and ethical territory.
At the beginning—and beyond
Bonny: Jennifer listened. She listened through my anger and tears to the core of what I was trying to say. She understood my need to become involved and respected the skills and perspectives I had to offer. She provided “just in time” education. She introduced me to the broader suicide prevention community. She invited me to review some of her research, was willing to engage in respectful dialogue, and incorporated some of my ideas. Over the years she has continued to encourage me to learn and contribute. Our voices don’t always agree, but the “edges” of our dialogue are where the learning is. We—and the projects we take on—are always enriched by working together.
Jennifer: At our ﬁrst meeting, I was immediately struck by the weight of Bonny’s grief. Like other parents I had met who had lost a child to suicide, Bonny’s energy was taken up with trying to make sense of this life-shattering, deeply painful loss. She had many questions and her hunger for more knowledge and her clear commitment to wanting to “do something” was evident from the start. Based on my ongoing meetings with Bonny and other survivors1 of suicide, I started wondering about how those of us who are professionally employed in the ﬁeld of suicide prevention might capitalize on the special kind of knowledge that survivors of suicide possess: how can their perspectives help us to examine how we “do suicide prevention”?
With so many theories, approaches and expert, survivor and consumer knowledge to listen to, how do we ever ﬁnd a way forward?
Bonny: As a business analyst, I ﬁnd there is this ‘mucking around’ phase when tackling a new area. People untangle the ‘lingo’ as they try to understand the current situation. They ask questions based on their expertise and experience. They discover who the stakeholders are and what skill sets are needed. The project team (and stakeholders) go through ‘forming, storming and norming’ as they get to know each other, value each others’ skills, trust each other and shift from their isolated views to understanding the perspectives and needs of other stakeholders. It is only through this messy-but-critical process that the group ﬁnally ﬁgures out the key issues and can begin working together toward effective solutions.
Jennifer: I agree. It is only when we are able to bring together diverse perspectives that we will be able to make a difference in reducing rates of suicide and suicidal behaviours. By relying exclusively on the interventions and judgements of “professionals and experts,” or by believing that traditional scientiﬁc knowledge is the only form of knowledge that can be relied upon to solve this complex, multi-dimensional problem, we risk turning the work of suicide prevention into a specialized practice in which only a few can participate, as opposed to a collaborative community endeavour that capitalizes on the resources and knowledge of a range of community members.
What are some current sources of concern, curiosity or uncertainty with respect to contemporary efforts in suicide prevention?
Bonny: The puzzle for me is the ‘disconnects.’ As I learned in a project management course, problems occur when stakeholders are excluded, when no single group has responsibility and accountability, or when groups need to collaborate and don’t. For example
Why do we just shrug our shoulders (or stay polarized) on the issue of conﬁdentiality?
Why don’t parenting books educate families on the warning signs of mental illness?
Why is family/gatekeeper input all too often excluded from suicide risk assessments?
Why is so little attention given to community/school response and support after a suicide attempt?
Why don’t we have coordinated, funded federal and provincial suicide prevention strategies?
Jennifer: What I’ve been curious about lately is how our research traditions in the ﬁeld of suicidology structure “what can be seen.” For example, the ﬁnding that 80% to 90% of those who die by suicide are suffering from some form of mental disorder has been empirically validated in several international studies and systematic reviews, leading to the acceptance of this observed relationship as a “clear fact.”
I agree that many suicides may have been prevented if individuals had received formal mental health treatment. At the same time, I also believe that human lives can be examined, understood and characterized through many other lenses, beyond the diagnostic ﬁlters typically used in the mental health ﬁeld. While the “psychological autopsy” method has helped us to better understand some of the characteristics of those who have died by suicide, this approach to studying suicide is inevitably limited to capturing those factors that can be named, isolated and quantiﬁed. Just because we can’t directly measure the effects of social and political inﬂuences (e.g., colonization, homophobia, social injustice) through our traditional research designs doesn’t mean these inﬂuences are not at play.
What are some of your greatest sources of hope in the suicide prevention ﬁeld?
Bonny: I am excited by the signs that indicate professionals, paraprofessionals and families are discovering the value of working in partnership:
The CASP Blueprint for a Canadian National Suicide Prevention Strategy is a collaboration between survivors, professionals and paraprofessionals
The Survivor Advocate Listserv is proving to be a valued informal information exchange among Canadian survivors, researchers, community/school suicide prevention teams and mental health practitioners. See groups.yahoo.com/group/SurvivorAdvocates.
Increasingly survivors are invited to sit on planning and advisory committees, document review teams, and to become active partners on research teams.
Jennifer: Hope, for me, exists in the quality and openness of the dialogues we are having about suicide prevention. It’s about who is included in the discussion and who has yet to be invited to the table. It’s in recognizing the legitimacy of multiple forms of knowledge and in creating spaces and processes for grappling with the complexity and pain surrounding the issue of suicide. It’s in the ‘messiness’ of it all that I think we have the best opportunity for living up to the ideal espoused in the message, “suicide prevention is a community responsibility.
Our invitation to you
Suicide is an ‘outcome,’ which emerges from multiple, unpredictable, complex and interweaving pathways. It is our belief that suicide prevention must include a wide array of personal, professional, clinical, social, cultural, spiritual, ethical and political practices. In the articles that follow, a range of personal and professional perspectives on suicide is presented, which collectively captures the rich and complex character of suicide prevention work. We invite you to join our conversation.
About the Authors
Bonny is a survivor1 of her 21-year-old son’s suicide. Before retiring, she was a business analyst. She is now Acting Vice-President and Chair of the Survivors Division of the Canadian Association for Suicide Prevention (CASP), and Project Manager of the Vancouver Suicide Survivors Coalition, a project of the Vancouver Community Mental Health Services’ Consumer Initiative Fund
Jennifer is Assistant Professor in the School of Child and Youth Care at the University of Victoria. She worked as a clinical counsellor at Vancouver Coastal Health’s SAFER Counselling Service. Prior to that she served seven years as Director of the Suicide Prevention Information and Resource Centre, Mental Health Evaluation and Community Consultation Unit, UBC Department of Psychiatry. Jennifer is a CASP award recipient and past board member
In the suicide prevention ﬁeld, survivor is a word used to describe someone who has lost someone signiﬁcant to suicide. It does not refer to those who have made a suicide attempt and “survived.”
Cavanagh, J., Carson, A., Sharpe, M. et al. (2003). Psychological autopsy studies of suicide: A systematic review. Psychological Medicine, 33, 395-405.